Care Access & Referral Navigator

Prisma Health; Columbia (SC); On-site; USD 25,000 - 39,000; Full time

Job summary

Prisma Health in Richland, SC seeks an organized front office specialist to manage referrals, precertifications, and patient scheduling. You will work with patients, physician offices, and third-party payors to obtain prior approvals and transmit clinical documentation.

You will document all actions, follow up on referrals, and maintain HIPAA compliance while delivering compassionate patient service. This role supports the Practice Operations department on site at Pulmonology 1 Med Park 300.

Qualifications

• Patient registration and/or electronic scheduling experience preferred.
• Experience with authorization/precertification processes preferred.
• Knowledge of health insurance processes and third-party payor communications.
• Familiarity with CPT/Diagnosis Coding and medical terminology.

Responsibilities

• Coordinate with outside and internal organizations and insurance companies to obtain prior approvals.
• Record demographic, coverage, and scheduling information in systems.
• Remind patients of appointments and ensure up-to-date PCP data.
• Document referral status and communicate with physicians and payors.
• Follow up after consults/tests to confirm reports are received.
• Maintain patient confidentiality and HIPAA compliance.
• Provide high-quality patient service and problem-solve barriers to care.

Skills

Customer service

Communication

Interpersonal skills

Health insurance knowledge

Medical terminology

CPT and Diagnosis Coding knowledge

Insurance verification

Authorization/precertification process

Microsoft Office

Education

High School diploma

Tools

Microsoft Office

Job description

Prisma Health in Richland, SC seeks an organized front office specialist to manage referrals, precertifications, and patient scheduling. You will work with patients, physician offices, and third-party payors to obtain prior approvals and transmit clinical documentation.

You will document all actions, follow up on referrals, and maintain HIPAA compliance while delivering compassionate patient service. This role supports the Practice Operations department on site at Pulmonology 1 Med Park 300.